MSU Extension Michigan Substance Use, Prevention, Education and Recovery (MiSUPER)

If an older adult were ill or needed help, most people would reach out and help in whatever ways they could. But, if the illness were alcoholism or drug abuse, it is often hard for most people to know what to do or say. Often, it is difficult to tell if what we see are symptoms of substance abuse. In older adults, these signs can seem to mimic other conditions, such as diabetes, dementia or depression. Even health care professionals have a difficult time diagnosing and treating older adults with substance use disorder.

According to a recent study, alcohol continues to be the most misused substance among adults over 65 years of age and this last decade has seen an increase in the rates of binge drinking and alcohol use disorder. The rates of prescription drug misuse among this same age group has also been increasing. Some experts have referred to this as the “invisible epidemic.”       

Is it substance misuse or abuse? The American Academy of Family Physicians notes there are two types of older adults living with alcoholism in their later life. Two-thirds of older adult alcoholics are early-onset, or those who have been heavy drinkers most of their adult lives. The other one-third are those who began to drink excess amounts in their older years, often in response to a difficult life situation or transition.

Misusing substances, even those prescribed by health care providers, can also lead to serious consequences. For example, physicians routinely prescribe tranquilizers, which are also known as sedatives, for older adults. “Tranquilizers are nervous system depressants that treat a wide range of symptoms such as acute anxiety, sleep disorders and panic attacks.” Xanax®, Ativan® and Valium® are examples of prescribed tranquilizers. More tranquilizers are prescribed annually than for all other medications (except for heart medication); that means over 16.9 million prescriptions each year. However, these medications can lead to an increased likelihood of respiratory distress if used other than prescribed. Combining alcohol and prescribed tranquilizers or sedatives can cause a dangerous slowdown of heart rate and breathing that can further cause coma or death.

What is substance misuse? Some of the common forms of prescription substance misuse include:

• Taking a medication prescribed for you in a higher quantity, frequency or length of time than prescribed by the healthcare provider.
• Taking your prescribed medication for a condition and/or health problem other than what it is was prescribed for. 
• Sharing your prescribed medication with others. This is not only misuse, but also illegal.

What are possible signs of misuse or abuse? Hazelden has identified several warning signs:

• Drinks alcohol despite warning labels while on prescription drugs.
• Always has bottles of tranquilizers or sedatives on hand and takes them at the slightest sign of disturbance.
• Is often intoxicated or slightly tipsy, and sometimes has slurred speech.
• Disposes of large volumes of empty beer and liquor bottles and seems secretive about it.
• Often has the smell of liquor on their breath or mouthwash to disguise it.
• Is neglecting personal appearance and gaining or losing weight.
• Complains of constant sleeplessness, loss of appetite or chronic health complaints that seem to have no physical cause.
• Has unexplained burns or bruises and tries to hide them.
• Loss of interest in activities and hobbies they used to enjoy.
• Seems more depressed or hostile than usual.
• Cannot handle routine chores and paperwork without making mistakes.
• Has irrational and undefined fears, delusions or seems under unusual stress.
• Seems to be losing their memory.

How can we begin to help our loved ones get help for substance misuse problems? Before talking to your older loved one or friend, talk to a professional trained in addiction and older adults. Prepare by gathering information:

• A list of prescribed and over-the-counter drugs the person is taking.
• A list of physicians and allied healthcare professionals the person is seeing. They may have a general practitioner and a specialist.
• A brief life history including religious and cultural background and important life events.
• An idea of the person’s present ability to live alone and take care of themselves.
• How drinking or the misuse of medicines is affecting their health, family, and social life, etc.
• A list of family members and friends who are concerned and would be willing to help, if necessary.

Together, you and the professional should be able to make an informal assessment as to what type of help the older person needs and how to approach the topic with them. You may decide, for example, that it would be better for your friend’s physician to bring up the problem, since many older people trust their doctors. Or perhaps you can ask another close person, such as a trusted faith advisor or an old acquaintance of your friend to sit down for a personal talk. Find out more at www.hazelden.org, the National Institute on Aging or Substance Abuse and Mental Health Services Administration (SAMHSA) treatment locator about how you can help your friend or loved one get help for substance misuse and abuse.

If the person is ready to make a change, the first thing to do is listen and be supportive. You may want to urge your friend to see a physician to get a professional assessment of the problem. They may be more willing to go if you offer to go with them. Depending on the severity, the older person may need hospital care to treat the physical symptoms of alcohol and drug reactions. Many older persons can benefit from inpatient treatment for alcoholism or drug dependency, if their health insurance or other resources will cover the costs.

Alcoholics Anonymous (A.A.) can be a good alternative, along with individual counseling from a substance abuse professional/specialist that is trained to work with older adults. Founded in 1935, A.A. has helped millions of people achieve sobriety. When you talk to an A.A. volunteer, ask for a meeting where an older person could be comfortable. See www.aa.org for more helpful information for friends and families of older adults dealing with substance abuse.

Fortunately, today it is more accepted to seek help for alcohol and drug misuse problems. There are excellent resources in many communities to help loved ones and friends address the issue. Michigan Department of Health and Human Services (MDHHS), Office of Recovery Oriented Systems of Care has information and resources on Prevention, Treatment and Recovery. Visit Michigan State University Extension’s Michigan Substance Use, Prevention, Education, and Recovery (MiSUPER) website to find out about our opioid misuse prevention efforts or to request a community presentation. 

For more about older adults and substance abuse, read Substance abuse in older adults: Underdiagnosed and undertreated.